Malaysia: Needle Syringe and Exchange Program (NSEP)

MALAYSIA: AN OVERVIEW

Malaysia Total population in 2011: 28.3 million Life expectancy 2011=72.1 male, 771. female Ethnically and religiously diverse (Malays 65.1%, Chinese 26%, Indians 7.7%) Religion is highly correlated with ethnicity Long history of colonization: Portuguese 1511-1641 Dutch 1641-1824 British 1824-1942 1998-1999=Asian Financial Crisis

Malaysian Government Malaysia is a federal constitutional monarchy and a parliamentary democracy. The Head of State is the Yang di-Pertuan Agong (King). The Head of Government is the Prime Minister, who is also the head of the Cabinet.

Malaysia’s development as a Welfare Regime After the long history of colonization: economic transformation (agrarian to industrialized). Incidence of poverty from 49% of all households in 1970 to 16% by 1990. More economically driven=economic expenditure has consistently received priority over social services. Refer to Ministry of Finance Report 2010

Malaysia’s development as a welfare regime Mixed of universalistic and targeting approaches. Healthcare system=principles of universal access, but divided into two sectors—the public and private. Civil service pension scheme, the Employees Provident Fund, public welfare programs. Social expenditures receives 32.92% from the total of public expenditure since the 1990s.

HIV/AIDS AND IDUs

HIV/AIDS and IDUs 1986-2002=steady increased of HIV/AIDS cases 2002=57, 835 HIV cases and 5,676 AIDS deaths Since the 1990s,IDU is the most common method of HIV transmission (74.2% in 2002) 1986-2002=males=90% of those infected with HIV (93.76%), AIDS deaths (93.3%) Lose potential human resources due to HIV epidemic.

HIV and AIDS cases

NSEP: A MODEL PROGRAM

WHY NSEP? CULTURAL HIV and IDUs more prominent in Malays Muslim (majority, male aged 19 to 59 yrs. Old, 70-90%) POLITICAL In 2005, failed to achieve one out of eight Millennium Development Goals Cost of FOC HAART

NSEP Description 2005, the government announced to implement NSEP In February and March 2006 Three states (big cities, high numbers of IDUs) Government provides USD 1.8 million to start NSEP

NSEP in Malaysia MAC allocates NSEP funding to NGOs Drop in centers (DICs), 16 in 2009 to 20 2012 Outreach workers (that cover 240 NSEP sites) Exchanging used needles and syringes for sterile ones. Safe disposal of used injecting materials. Reaching out and educating people who inject drugs (PWID)on HIV/AIDS and other related health issues. Providing PWID with referrals, rehabilitation, health and welfare agencies. Encouraging safer sex practices through education and condom distribution.

NSEP=SIMILARITIES & DIFFERENCES IDUs ZER0-DRUG TOLERANCE NSEP PREVENTION & MANDATORY SCREENING NSEP=SIMILARITIES & DIFFERENCES

NSEP differences and similarities Differences=drug use (Drug Laws and treatment/rehabilitation centers). Drug laws to approach IDUs (Dangerous Drug Act 1952 Similarities=HIV/AIDS=use NGOs to provide NSEP. NGOs = provide social services to address HIV/AIDS issues since 1987 (first HIV cases). Malaysian AIDS Council (MAC)-main NGOs or umbrella for all NGOs that related with HIV/AIDS social services.

STRENGTHS, WEAKNESSES AND CURRENT ISSUES

Behavior surveillance survey (BSS) I & II (n=300) NSEP BSS I (APRIL 06) -49% always use new and clean -44% NSEP -52% sharing BSS II (DEC 07) -41% always new and clean -88% NSEP -42% sharing Behavior surveillance survey (BSS) I & II (n=300)

NSEP STRENGTHS Reduced HIV transmission among the IDUs 74.2% in 2002 to 71.2% in 2007. In 2009=18, 377 IDUs accessing NSEP In 2011=8,904 new registered clients = 33, 344 IDUs access NSEP within 5 years

ACHIEVEMENTS & COVERAGE 2011

Weaknesses Malaysia=conservative government=society= considered any program involving drug users as a waste because history reveals that many drug users did not recover fully (90% relapse rates). NSEP sites=public sensitivities Some stakeholders (religion leaders, police, law enforcement, prison departments, rehabilitation centers)=view this program as wasteful, contrary to religious belief and law.

Current issues In 2003, government declared a ‘Year of Total War against Drugs’. Conflict with law enforcement (Dangerous Drug Law/Act) 1952 and Ops Tapis Law In 2000=80, 8893 drug users were arrested under the Ops Tapis law, increasing to 135,159 by 2003 ACCESS TO NSEP? STILL LESS THAN 15%

TERIMA KASIH!